Over- and underestimation of motor ability after a stroke: Implications for anosognosia

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We administered a discrepancy-based measure of anosognosia for hemiplegia (AHP) to a group of 42 right-brain-damaged (RBD) and left-brain-damaged (LBD) stroke patients with varying levels of functional motor ability. In addition to the expected (anosognosic) pattern of overestimation of motor function in some RBD patients, we found an equal and opposite underestimation in some others, both RBD and LBD. We also found that around a quarter of self-estimation error could be predicted directly from actual ability, such that patients with poorer motor function tended to overestimate, and vice versa. This pattern suggests that some misestimation is attributable simply to statistical regression. However, even after adjusting for this regression effect, levels of overestimation were significantly greater in RBD patients, while LBD patients were more likely to underestimate their motor ability.HighlightsExtreme over- and underestimation of post-stroke motor ability was observed.One quarter of the variation in misestimation was attributable to actual ability.Right-brain-damaged patients both over- and underestimated.The only extreme misestimation in left-brain-damaged patients was underestimation.Underestimation was associated with lower moods.

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